| NPI | 1851708499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT000641A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE1000887) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |